Thursday, April 19, 2007

I just spent the last two days at a "disparities in healthcare" conference. I saw some phonomenal speakers, but my favorite session was on perinatal care. There seems to be a shift occurring from a focus on 'prenatal' care to 'intraconception' care. While I think there is certainly some merit to catching at risk and other women before they become pregnant, I don't believe we've begun to explore all that prenatal care can and should be. It should be more than an hour's wait for a 5 minute BP check and pee dip. The centering pregnancy model came up and while I think that's a good start, there is a real need for innovation in prenatal care. One speaker on the perinatal panel, an epidemiologist, showed an older study he had done from 1999, that prenatal care was not impacting outcomes. It didn't bother me much that the study was old, because I know things haven't really improved. Women are disillusioned with childbirth education and with prenatal care. Both need major overhauls or risk becoming obsolete (not done away with, just lowly regarded). We really need new models of care, not just new gimmicks and clever new ways of packaging the same old, same old. Models that are inclusive, empowering, and impactful. We are in a new day, that calls for a new approach.

Wednesday, April 18, 2007

I finished my article for the local paper about my homebirth. My Dear Readers get an advanced peek:

Birthing My Way

“Baby’s coming…” I found myself panting. Quick as a wink, I could feel the baby move downward and out. The midwife rushed to my side, the doula on the other. I was surprised to hear her say the head was already out. I kept pushing. In one long smooth push the baby fully emerged. I snatched my baby from the midwife’s arms, greedy to hold and see him. I had birthed in a standing position so she had to pass him between my legs. I turned around and sat down on the chux covered sofa. My husband sat beside me and in another minute our other children came rushing in to see the new baby, Lucy, the family dog, fast on their heels. It seemed appropriate that I had birthed in the ‘family room’ of our home. (I don’t care for birthing in bed, and didn’t want one in sight, so I selected a room with a sofa instead. It worked perfectly, I stood leaning on the birth ball during contractions, which lessened the discomfort greatly, and sat on the sofa to rest between them.) My baby finally in my arms, I couldn’t stop laughing. The video of my birth shows me clutching my newborn, surrounded by my family, and laughing my head off for several minutes. I had birthed my baby. my way, at home surrounded by those of my own choosing. Within the hour I was showered and tucked into my own bed, settling down to nurse my baby. I relished the delicious pancakes and glasses of ice cold milk my husband had prepared for us all. Birthing my ninth baby at the age of 44 at home with a midwife was the healthiest and safest choice for me and my baby. I desired a birth free of unnecessary intervention (which carries its own risk) and to birth without distraction. I wanted a birth where I was the focus, and I had ultimate control over what went on. As a former labor and delivery nurse, I knew full well how I would be seen by the medical system. Doomed to “high risk” status because of my age and previous births (all normal and healthy), I knew I could never subject myself or my baby to all the unnecessary intervention to appease someone else’s fears. I was determined to birth at home, just as I had with my previous five babies (the first three were born in hospitals). It took some doing to find a midwife for my birth. Though I’ve used only midwives for well-woman care for the last 20 years, my current hospital-based midwife was not allowed to do home deliveries. My husband and I sadly severed ties with her for the duration of the pregnancy, since she could not knowingly see someone for prenatal care who was planning a homebirth. We found just what we were looking for in a neighboring town. We found a certified nurse midwife with a homebirth practice who would not view me as a disaster waiting to happen. It was an hour’s drive to her home for prenatal care, but well worth it for the relaxed leisurely, unheard of hour long visits (with no waiting). We did the usual weight and blood pressure checks, but I eschewed all but the most basic lab work and tests. We mostly talked about my diet and exercise, and my mental, emotional and physical preparation for birth. Our focus was on healthy behaviors that would support a healthy pregnancy and birth. I relished this focus on normality and wellness and was so thrilled with the pregnancy, that I made the decision to both blog and film the entire experience. I went on to blog my entire pregnancy and birth at http://homebirthdiaries.blogspot.com even blogging several entries during my labor! I not only became a devoted blogger but became quite addicted to birth blogs by others. I found an on-line community of women and care providers supporting wellness-focused pregnancy, unlike anything I had experienced as a birthing mother or a labor and delivery nurse. I hired a British documentary filming team to film me during pregnancy and of course birth. I also made the decision to write a book about my nine birth experiences and my odyssey from teen mom to labor and delivery nurse to well-birth advocate. I’ve heard it glibly commented, that pregnancy is not an illness, yet we treat it like one nonetheless. I was delighted to spend my ninth pregnancy and birth making healthy choices that focused on what goes right with birth rather than what could go wrong.

Monday, April 16, 2007

I've been working on an article for a local paper about my homebirth. My goal, of course, is to sound sane and rationale and defend my choice in a plausible manner. Beyond that, I'd like to stir in readers a belief that this kind of birth might be possible for them, or at least get them to think what a nice way to birth this is. Until the problems are acknowledged, there can be no work toward solutions. There is a hot and heavy debate in the Missouri House and Senate (even as we type!) about the legalization of midwifery (CPMs). I would love to weigh in on this, send letters, sign petitions, testify before congressional committees, but unfortunately I don't live in Missouri so I'm keeping tabs on things from across the state line. This is the latest in a long long line of attempts to pass a Bill legalizing midwifery. Perhaps this time, it will pass... In the meantime I have a story to tell.

Saturday, April 07, 2007

I took the radical step of getting a coach. A coaching group to be exact. I joined a group facilitated by an executive coach. I felt the need for more focus and more accountability in my life. I'm being challenged to think in new ways in order to accommodate change. We'll see how it goes.

Sunday, April 01, 2007

For those who may not know, my "day" job involves teaching CPR. Talk about opportunity to move out of my comfort zone. One day I'm teaching an over-50s motorcycle "gang" preparing for a cross-country ride, and the next I'm teaching a group of burka-covered ladies in an Islamic daycare. I've made an intention to become comfortable around all kinds of people (I believe this will be key to my success). Stepping into a room full burkas two days ago is a case in point. When I arrived I didn't know what to expect. The first person to greet me, was a young woman smartly dressed in a festive robe (not all black like most of the others). She was a pretty young thing, warm and friendly and giggly. She led me to her classroom to set up my things. As I entered the darkened room, and began to unpack my mannikins and supplies, I was suddenly startled by 3 women, dressed all in black, who were kneeling and praying on a rug in a corner of the room. I was there about 5 minutes before I noticed them, as they were getting up. I began to wonder if I could pull this off. I know hardly anything about Islam, most of it not good. I became acutely aware of what I was wearing, African robes. No, I didn't plan it that way, I always wear this stuff! (I like long flowy clothing.) Even so, I was showing a lot of skin next to the ladies covered head to toe. And then, there was my naked shaved head. Okay, not really shaved, but my sculpted Afro really stood out next to all the head coverings. I remembered calling on the universe to grant me opportunities for growth. This certainly fit the bill. But as I started the class and was my usual effervescent self, I noticed that these ladies were not terribly different from me and my friends. As we progressed through the four hour class, shoes and scarves came off, jokes and laughter abounded as the women took turns bandaging one another's broken arms and legs during first aid practice. Another observation, these women were every color of the rainbow, the diversity of their gathering unlike any I'd seen in any church. The bubbly young woman, aptly named Sunni, revealed that she was pregnant with her first baby. I really liked her, she was as sweet as pie, and so much like any other newlywed expecting a first baby. In the end, I relaxed and had a great time. The entire experience was rewarding and enriching. Thanks, universe. What next? I can hardly wait.

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Teacher, Storyteller, and Birth Activist

The Mission

LaborPayne has a masters in nursing education and works as a nursing instructor teaching maternal infant health. She is a lactation consultant candidate and a CNM (certified nurse midwife)student at Kansas University. Upon completion of her midwifery studies, she plans to pursue a MPH/PhD dual degree. She has been a doula and childbirth educator for 20 years, a nurse for 12 years, worked labor and delivery for 8 years, and has taught for 3 1/2 years. She owns Perinatal ReSource an education, training and consulting firm, and The CPR Lady, a safety training firm. In addition to authoring this blog, she is an editor for Clinical Lactation Journal, and sits on the board of CIMS, Coalition to Improve Maternity Services. She also sits on her local FIMR Board (fetal infant mortality review) as well as her city and state breastfeeding committees. She presents nationally on perinatal issues. Her career goals include decreasing perinatal morbidity and increasing lactation rates in the African American community through published investigative research and application of evidence based clinical practice. She also has plans to open a community based birth center in the urban core.